Discusses screening test for hereditary hemochromatosis, a genetic disorder that causes the body to absorb too much iron. Covers symptoms of hereditary hemochromatosis. Discusses who should be screened and offers reasons not to be screened.

Hemochromatosis Genetic Screening

What Is Hereditary Hemochromatosis?

Hereditary
hemochromatosis is a disorder that causes the body to absorb too much iron.
This causes iron to build up in the blood, liver, heart, pancreas, joints,
skin, and other organs.

In its early stages, hemochromatosis can
cause joint and belly pain, weakness, lack of energy, and weight loss. It can
also cause scarring of the liver (cirrhosis), darkening of the skin,
diabetes,
infertility,
heart failure, irregular heartbeats (arrhythmia), and
arthritis. But many people do not have symptoms in the
early stages.

In men, hereditary hemochromatosis is usually found
at ages 40 to 60. In women, it is not usually found until after
menopause because, until that time, women regularly
lose blood and iron during their monthly periods.

What Causes Hereditary Hemochromatosis?

Hereditary
hemochromatosis is a
genetic disorder called an
autosomal recessive disorder. It is passed from a parent to a
child (inherited). Most people who have hemochromatosis inherit defective genes
from both parents. In rare cases, a person can have hemochromatosis by
inheriting defective genes from just one parent.

A person who has
inherited only one defective gene will most likely be a
carrier of hemochromatosis and will not have the
disease. A carrier can pass the defective gene on to his or her children.

If only one parent is a carrier of a defective
gene, the child will not have hemochromatosis. But there is a 50% chance that
the child will be a carrier.

If both parents are carriers, there is
only a 25% chance that the child will have both defective genes and so will
have a higher risk of getting hemochromatosis. But there is a 50% chance that
the child will be a carrier.

What Is Hemochromatosis Genetic (HFE) Screening?

Screening tests help your doctor look for a certain disease or condition
before any symptoms appear. This can increase your chance of finding the
problem at a curable or more treatable stage.

Hemochromatosis gene (HFE)
testing is done to check to see if a person is likely to develop hereditary
hemochromatosis. This test checks whether you are a carrier of the
defective gene that causes hemochromatosis. HFE testing locates gene mutations that are called
C282Y and H63D. The test can usually confirm whether a person has an increased
chance for having hereditary hemochromatosis.

HFE testing identifies a genetic risk rather than the
disease itself. Even if you have one or more HFE gene mutations, you may never get sick.

Who Should Be Screened?

Screening is only recommended for people who have an increased chance of having
the disease, such as those with other family members who have hereditary
hemochromatosis. The test may be ordered if you have
a close family member—parent, brother, sister, or child—with the
condition. It is best to get tested
when you are age 18 to 30 when tests can usually detect the disease before
serious organ damage occurs.

Genetic counseling to help you understand the meaning
and possible results of the test is recommended before having genetic
testing.

The U.S. Preventive Services Task Force (USPSTF) does not recommend genetic screening for
hemochromatosis in the general population.1 Screening is not recommended for the general population because hemochromatosis is not common. The
general population includes people who do not have symptoms of hemochromatosis
and who do not have a parent, brother, sister, or child with the
disease.

Anyone can have the test, but a doctor must order it. You
may decide to have HFE testing if other people in your family have hereditary
hemochromatosis and:

You want to see if you have the gene mutation too.

You want to see how likely it will be that you will pass
the disease on to your children.

Is Screening Accurate?

The HFE screening test is very accurate in finding the common mutations in the HFE gene. But only about 85% of hemochromatosis is caused by the mutations found by the HFE screening.2, 3 Even if you have HFE mutations, you may not have the
disease. Or, you may have the disease, but gene testing did not find the mutations that are causing the disease.

Should I Be Screened?

The decision to have
hereditary hemochromatosis carrier screening is a personal one.

This testing is used to find out if a
person has an increased chance for having hemochromatosis. It may be
recommended for people who have a close family member—parent, brother, sister,
or child—with this disease.

Carrier
testing is expensive. If you are paying for the test, you will want to consider whether the cost of the testing is worth the results.

The discovery of a genetic disease that is not causing symptoms now should not affect your future ability to gain employment or health insurance coverage. A law in the United States, called the Genetic Information Nondiscrimination Act of 2008 (GINA), protects people who have DNA differences that may affect their health. This law does not cover life insurance, disability insurance, or long-term care insurance.

Why Not Be Screened?

There may be reasons you would
choose not to have carrier testing.

You think that your risk of being a carrier is low. This
may be true if you are of African or Asian descent. Fewer people
in these groups have hereditary hemochromatosis.

Carrier testing
is expensive. You may decide not to have testing if your insurance does not pay
for it.

Testing is not always able to predict if you will have
hereditary hemochromatosis. Although the test detects the most common
hemochromatosis gene (HFE) mutations, there may be other HFE mutations that the
test does not detect. There is a small chance that you are a carrier even if
the results are normal because there may be other HFE mutations that the test
does not find. HFE gene testing is usually not used to check for other, less
common causes of inherited hemochromatosis.

National Human Genome Research Institute (2010). Learning about hereditary hemochromatosis. Available online: http://www.genome.gov/page.cfm?pageID=10001214.

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